Global implications of evidence ‘biased’ practice: management of the third stage of labour

Increasing attention is being paid to the promotion of clinical and cost-effective care informed by the highest level of evidence to ensure health outcomes are optimised and access to health care is equitable. There are obvious advantages to these approaches, including increased awareness of the importance of rigorous methodology when conducting primary and secondary research, utilising methods which are systematic, robust, transparent and explicit.

Evidence-based practice was introduced to replace the traditional approach of ‘this is how we have always done it’ as an underpinning for clinical practice. Ironically, however, the transition has not been straightforward and there have been criticisms of the way ‘evidence’ to support some areas of practice is perceived and applied in clinical settings. Anecdotally and based on personal experience, there are two main criticisms:

1. Acceptance of evidence without critique: Too much faith (or blind faith) in the process by which ‘evidence’ (authoritative or systematic) is produced.

2. Lack of holistic insight in the application of evidence: Employing ‘one size fits all’ policies ignoring individual needs for required care in conveyor-like processed care provision.

To explore these criticisms, the example of management of the third stage of labour is used.